title: A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey.
abstract: OBJECTIVE
  This study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure.
  
  
  METHODS
  Prospective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March-October 2009 (preformalisation of TTS) and December 2009-September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months.
  
  
  RESULTS
  A total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 %, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 %, P = 0.43), and 6 months (3.8 vs. 3.3 %, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 %, P < 0.001). Functional outcomes for both cohorts were similar at 1 and 6 months follow-up.
  
  
  CONCLUSIONS
  This is the first study to evaluate missed injury rates after hospital discharge and demonstrated cumulative missed injury rates >15 %. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 %), this did not decrease missed injury rates.
authors.affiliation: Emergency Department, Gold Coast Health Service District, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia, gerben_keijzers@health.qld.gov.au.
authors.forename: Gerben B
authors.initials: GB
authors.lastname: Keijzers
authors.forename: Don
authors.initials: D
authors.lastname: Campbell
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hooper
authors.forename: Nerolie
authors.initials: N
authors.lastname: Bost
authors.forename: Julia
authors.initials: J
authors.lastname: Crilly
authors.forename: Michael Craig
authors.initials: MC
authors.lastname: Steele
authors.forename: Chris
authors.initials: C
authors.lastname: Del Mar
authors.forename: Leo M G
authors.initials: LM
authors.lastname: Geeraedts
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D014194:Traumatology / Q000592:standards*; D014947:Wounds and Injuries / Q000175:diagnosis*